February 17, 2014

What the Heck is mHealth?

Wanted: White knight (shiny amour optional) to save us from ourselves and the wretched lifestyles we choose.

Your coffeemaker went dead on you this morning, and while lamenting your drowsiness at work, your friend Denise mentions that she just bought a new coffeemaker at Target and she absolutely loves it. You take your coffee the same way Denise does, black, strong, and all day long, so you decide to buy one for yourself. You are a busy professional and you don’t have time to go to Target, search for a good parking spot, walk to the store, walk around until you find the small appliances, pick it up, stand in line, walk back to the car, struggle to back out from the too narrow parking space, and drive home through congested intersections. It could easily take half an hour out of your already busy day. So you decide to buy it online in the evening. You get home, feed the kids, answer a couple of urgent emails from your boss, and after everybody goes to bed, you settle down to finish those spreadsheets you meant to complete at your office, but ran out of time. In between emails and spreadsheets, you remember your coffeemaker, browse to Amazon.com, search for it, find it, and are getting ready to order when you notice that the ratings are not stellar. It seems that 347 shoppers, just like you, gave it only 3 stars. Surely you can do better than that. So you search for coffeemakers in general, find a whole bunch, sift through ratings after ratings, and learn that people that bought a coffeemaker also bought filters and funny little measuring spoons. An hour later, you settle on some other coffeemaker, throw in a gold filter that never needs replacing, some organic rainforest coffee, and a box of genuine Italian biscotti that the raters say go great with your green coffee, and order the whole bunch from Amazon, which gives you free two days shipping with one click of a button. You feel very efficient and very accomplished. You just spent twice as much time as shopping at Target would have taken, sitting on your chair in the comfort of your home, spent twice as much as you intended, and for the next three months or so, every time you open a browser, some well-meaning retailer will be providing you advice on what else you need to buy to make your coffeemaker happy. You have proven that you are a good and savvy consumer, and now you can advance to the next level, and try your hand at consuming health care.

The first order of business is to place health care at your fingertips so you can shop for it while sitting motionless on a chair, in the comfort of your home. Going to an actual doctor is as inconvenient and as detrimental to your worker productivity as going to an actual store, and probably much worse, because once you enter the doctor’s office, you are denied the freedom of choice that comes from being able to compare ratings and opinions of other savvy shoppers like you, and barred from accessing the benevolent advice freely available on websites. Health care shopping is the ultimate level in this game, so it requires new tools, collectively known as mHealth, or mobile health. Mobile, not because God forbid you may have to move to use them, but because these sophisticated tools do all the moving for you, much better than the old fashioned Amazon.com ever did. mHealth can attach itself to your pocket, your clothes, your wrist, your underwear, your skin, your eyes, and can even nestle comfortably inside your body. mHealth does not need you to summon it into existence like Amazon.com did. mHealth is always there, tirelessly working on your behalf, anticipating every muscle twitch, every thought and every desire you may have, providing you with healthy advice and support in your times of need, even in your sleep. Like a good butler of days gone by, mHealth makes it its business to quietly learn everything there is to know about you, so it can provide you with a level of personalized service, once only available to fabulously wealthy individuals, and now available for free to every convenience seeking pauper.

As of February 10, 2014, the Apple iStore contains 29,504 health & fitness apps, and 23,420 medical apps. Together, these apps are known as mHealth. Most are free, some cost a few cents and some have substantial pricing. Most are standalone, simple things, and a few are part of larger elaborate systems of smart hardware, some wearable, others to be used at certain times only. They range in scope from expert advice on where to buy pesticide free eggplant to FDA approved medical devices for measuring the function of your heart. There is only one thing all mHealth apps have in common: they all collect information about you. Collectively, mHealth knows when you are sleeping and knows when you’re awake. It knows what you are eating, when you eat it, and where you are while you eat it. It knows if you are walking or running or just sitting down. It knows your vital signs, your mood, your diagnosed ailments and all the medications you are taking. It knows who your friends are, what they look like and sometimes what they are eating too. It knows more about you than your spouse, your mother or your children. And since mHealth is a social animal, it is happy to share all that knowledge with the world, so the world can better cater to your specific needs. And the world is eager to reciprocate and share everything it knows about you with your mHealth. From Amazon.com to Target, the IRS, the DMV, MasterCard, the Department of Homeland Security, your alma mater and even your own car, everybody will be joining forces to serve your health in more and better ways.

There is one small problem though, and that’s your secretive relationship with your doctor. For some reason, doctors insist on talking to you alone, behind closed doors, like criminals. They say things, you say things, maybe you all look at things, and nothing gets transmitted to your mHealth. The world and mHealth can’t really help you if you keep secrets from them. The government, acting on behalf of the world at large, is now installing computers in doctors’ offices and mandating disclosure of your secretive conversations. That’s a good first step, but the ill-fitting EHR technology is still unable to communicate with the world, let alone your mHealth. To speed things up a little, the government is paying doctors to make you manually transmit your previously secret information to your mHealth. With one click of a blue button, you can liberate decades of your most private secrets, and send them to roam free through all the mHealth apps out there and combine themselves in most fortuitous ways with data from Amazon, Target, Verizon and all other agents toiling on your behalf.

And if you think this is some sort of utopian wishful thinking, I suggest you read the recent issue brief from the Office of the National Coordinator for Health Information Technology (ONC), about the government’s plans on “Using Health IT to Put the Person at the Center of Their Health and Care by 2020”. It’s only eight pages long, with large fonts and soaring rhetoric that mentions the word physician only once and makes no reference to doctors, because this is all about you, the person and future patient. By 2020, the ONC envisions that “The power of each individual is developed and unleashed to be active in managing their health and partnering in their health care, enabled by information and technology.” You get goosebumps just thinking about the tens of thousands of elderly folks with heart disease, cancer, and dementia, suffering in silence and yearning since the Second World War to have their powers developed and unleashed.

This wonderfully clear ONC manifesto, lays out a roadmap to a “brighter, more inclusive future”, enabled by the “emergence of health IT, including consumer eHealth tools” (a.k.a. mHealth).

A future where: “Individual self-determination and the public good are both optimized”

A future where we: “Motivate policymakers, employers, and other stakeholders to establish guidelines and environments that promote and support healthy behavior”

A future where we: “Soften or erase the boundaries between what occurs inside and outside of the health care system by promoting increased information flow”

A future where we: “Encourage providers to value patients and their data”

A future where we: “Build appreciation for and competence in technology-enabled self- and shared management of health and health care, by both providers and individuals”

A future where we: “Encourage interaction in online communities via social media”

A future where we: “Facilitate the aggregation of health and health care information for individuals and populations from diverse sources, including non-clinical information if desired”

A future where we: “Promote technology that shows trends in diverse health status measures, including deviations from normal for the given individual”

A future where we: “Promote easy-to-use technologies that integrate individuals’ health activities and treatment into the rest of their lives, where and how they already live, work, and play”

This is just a happy roadmap and ONC is not certain if “consumers and providers will fully embrace the resulting cultural shift”, but they are “optimistic that stakeholders will rise to these challenges”. I am too, and Mr. Kurt Vonnegut was already optimistic back in the middle of the previous century. Unfortunately, Mr. Vonnegut died before his power could be developed and unleashed, and thus was spared the joy of watching the stakeholders rise with the shifting cultures, but wherever you are Kurt, here is a rainforest coffee toast to your prescience. Amen.